Selma Omer

University partnership to address the shortage of healthcare professionals in Africa

Abstract The shortage of qualified health professionals is a major obstacle to achieving better health outcomes in many parts of the world, particularly in Africa. The role of health science universities in addressing this shortage is to provide quality education and continuing professional development opportunities for the healthcare workforce. Academic institutions in Africa, however, are also short of faculty and especially under-resourced. We describe the initial phase of an institutional partnership between the Muhimbili University of Health and Allied Sciences (MUHAS) and the University of California San Francisco (UCSF) centred on promoting medical education at MUHAS. The challenges facing the development of the partnership include the need: (1) for new funding mechanisms to provide long-term support for institutional partnerships, and (2) for institutional change at UCSF and MUHAS to recognize and support faculty activities that are important to the partnership. The growing interest in global health worldwide offers opportunities to explore new academic partnerships. It is important that their development and implementation be documented and evaluated as well as for lessons to be shared.

Lack of Annexin 1 Results in an Increase in Corticotroph Number in Male but not Female Mice

Annexin 1 (ANXA1) is a member of the annexin family of phospholipid‐ and calcium‐binding proteins with a well demonstrated role in early delayed (30 min to 3 h) inhibitory feedback of glucocorticoids in the pituitary. We have examined corticotrophs in wild‐type and ANXA1 knockout mice to determine the effects of lack of ANXA1 in male and female animals. Anterior pituitary tissue from ANXA1 wild‐type, heterozygote and null mice was fixed and examined (i) by confocal immunocytochemistry to determine the number of corticotrophs and (ii) by electron microscopy to examine the size, secretory granule population and secretory machinery of corticotrophs. No differences in these parameters were detected in female mice. In male ANXA1 null mice, there were approximately four‐fold more corticotrophs than in wild‐type animals. However, the corticotrophs in ANXA1 null mice were smaller and had reduced numbers of secretory granules (the reduction in granules paralleled the reduction in cell size). No differences in the numerical density of folliculo‐stellate, gonadotroph, lactotroph or somatotroph cells were detected in male ANXA1 null mice. Plasma corticosterone, adrenocorticotrophic hormone (ACTH) and pituitary pro‐opiomelanocortin mRNA were unchanged but pituitary ACTH content was increased in male ANXA1 null mice. Interleukin (IL)‐6 pituitary content was significantly elevated in male and reduced in female ANXA1 null mice compared to wild‐type. In conclusion, these data indicate that ANXA1 deficiency is associated with gender‐specific changes in corticotroph number and structure, via direct actions of ANXA1 and/or indirect changes in factors such as IL‐6.

Teaching and educational scholarship in Tanzania: Faculty initiative to improve performance of health professions’ students

Well-educated and competent health professionals influence the health system in which they work to improve health outcomes, through clinical care and community interventions, and by raising standards of practice and supervision. To prepare these individuals, training institutions must ensure that their faculty members, who design and deliver education, are effective teachers. We describe the experience of the Muhimbili University of Health and Allied Sciences (MUHAS) in encouraging improvements in the teaching capacity of its faculty and postgraduate students triggered by a major institutional transition to competency-based education. We employed a multi-stage process that started by identifying the teaching and learning needs and challenges of MUHAS students and faculty. Collaborating with the University of California San Francisco (UCSF), MUHAS responded to these needs by introducing faculty to competency-based curricula and later to strategies for long term continuing improvement. We demonstrate that teaching faculty members are keen for local institutional support to enable them to enhance their skills as educators, and that they have been able to sustain a program of faculty development for their peers.

Health professions educators as agents of change in Tanzania: Creativity to implement new curricula

Muhimbili University of Health and Allied Sciences (MUHAS) strives to instill in its graduates skills and competencies appropriate to serving the Tanzanian population well. MUHAS leadership, working in collaboration with educators from the University of California San Francisco (UCSF), selected and trained an interdisciplinary group of faculty members to promote effective teaching. We describe the development of this group of faculty change agents – now known as the Health Professions Educators Group (HPEG). The HPEG invigorated the education environment at MUHAS by: engaging many colleagues in special training events that introduced new methods for teaching and assessment; encouraging innovation; and developing strong mentoring relationships. HPEG members piloted courses in education to prepare all postgraduate students as peer educators, teaching assistants, and as candidates for faculty future appointments. Creation of a ‘teaching commons’ reinforces the new focus on innovative teaching as faculty members share experiences and gain recognition for their contributions to quality education.

The influence of 17 -estradiol on annexin 1 expression in the anterior pituitary of the female rat and in a folliculo-stellate cell line

Annexin 1 (ANXA1) is a Ca2+- and phospholipid-binding protein that plays an important role as a mediator of glucocorticoid action in the host-defence and neuroendocrine systems. Sex differences in hypothalamo–pituitary–adrenal (HPA) axis activity are well documented and a number of studies have demonstrated that gonadal steroids act as regulators of HPA activity. The aim of this study was to investigate the effect of ovariectomy and 17β-estradiol replacement, and estrous cycle stage, on anterior pituitary ANXA1 content. The amount of anterior pituitary ANXA1 determined by western blotting varied with estrous cycle stage with a peak at estrus declining to a trough at proestrus. Ovariectomy resulted in a significant (P<0·05) decrease in anterior pituitary ANXA1 content. Administration of 17β-estradiol (1 μg/100 g) significantly (P<0·01) increased anterior pituitary ANXA1 expression in the ovariectomized animals. In contrast, there was no change in pituitary ANXA1 content in response to 17β-estradiol in adrenalectomized and adrenalectomized/ovariectomized rats. Treatment of TtT/GF cells, a folliculo-stellate cell line, with 17β-estradiol (1·8–180 nM) increased ANXA1 mRNA expression and increased the amount of ANXA1 protein externalized in response to a dexamethasone stimulus. These results indicate that 17β-estradiol stimulates ANXA1 expression in the anterior pituitary and in vivo an adrenal factor contributes to the mechanism of action.

Identification of two alternate splice variants of a novel serine protease expressed in steroidogenic tissues

During the search for the serine protease that cleaves pro-gamma-melatropin to stimulate adrenal growth, we identified another novel protease, which we called Adrenal mitochondrial protease (AmP). In situ hybridisation detected AmP transcripts in steroidogenic tissues such as the brain, testis, in ovarian follicles as well as in the adrenal cortex. Full length cloning identified two splice variants differing by a 222 nucleotide insertion in the 5′ end of the short variant. The shorter variant codes for a 371 amino acid protein of 40.7 kDa and computer analysis predicts it to be targeted to the cytosol while the longer 445 amino acid protein of 48.4 kDa is mitochondrial. Cellular targeting was confirmed by tagging with GFP. The short variant was clearly cytosolic however, the cells expressing AmP-Long had large vacuoles, possibly as a result of distended (apoptotic?) mitochondria. Due to the mitochondrial localisation of the long variant of the protease and its expression in steroidogenic tissues, it may be expected to be involved in the steroidogenic pathway, possibly by cleaving steroidogenic acute regulatory protein (StAR). We investigated this by co-transfecting AmP-Long with StAR and F2 plasmid into COS-1 cells and measuring the effect on pregnenolone production. It was found that AmP-Long has no effect on steroidogenesis nor cleaves StAR as was shown by western blot analysis using StAR antibody.

Applying Innovative Educational Principles when Classes Grow and Resources Are Limited: Biochemistry Experiences at Muhimbili University of Allied Health Sciences.

Teaching to large classes is often challenging particularly when the faculty and teaching resources are limited. Innovative, less staff intensive ways need to be explored to enhance teaching and to engage students. We describe our experience teaching biochemistry to 350 students at Muhimbili University of Health and Allied Sciences (MUHAS) under severe resource limitations and highlight our efforts to enhance the teaching effectiveness. We focus on peer assisted learning and present three pilot initiatives that we developed to supplement teaching and facilitate student interaction within the classroom. These included; instructor‐facilitated small group activities within large group settings, peer‐led tutorials to provide supplemental teaching and peer‐assisted instruction in IT skills to enable access to online biochemistry learning resources. All our efforts were practical, low cost and well received by our learners. They may be applied in many different settings where faculties face similar challenges.

Vascular endothelial growth factor secretion from pituitary folliculostellate cells: role of KATP channels.

Vascular endothelial growth factor (VEGF) is an endothelial cell mitogen responsible for physiological and pathological angiogenesis. Abnormal regulation of VEGF expression in anterior pituitary folliculostellate (FS) cells has been implicated in pituitary tumour progression. FS and endocrine cells express VEGF, which is considered to be secreted by the constitutive pathway. The present study investigated the mechanism of VEGF secretion in TtT/GF cells, a mouse FS cell line. TtT/GF cells were shown to express VEGF164, the most potent and bioavailable isoform of VEGF. Immunofluorescence and immunogold electron microscopy localised VEGF to the cytoplasm and small electron‐lucent vesicles. Pituitary adenylate cyclase‐activating polypeptide (PACAP), a well‐documented stimulant of VEGF secretion, caused a robust increase in VEGF secretion over 24 h. Glyburide, an ABCA1 and KATP channel blocker, also caused an increase in VEGF secretion when applied alone, and amplified the response to PACAP. Other ABCA1 transport blockers did not affect VEGF secretion. Exposure of TtT/GF cells to cycloheximide with PACAP or glyburide inhibited the increased secretion of VEGF, consistent with control of secretion at the transcription level. The SUR2B/Kir6.1 form of KATP channels was shown to be expressed by TtT/GF cells. Diazoxide, a KATP activator, inhibited PACAP‐ and PACAP + glyburide‐stimulated VEGF secretion but not that of glyburide alone. These data suggest that KATP channels are expressed by FS cells and play a significant role in the control of VEGF secretion, and also that activation of KATP channels inhibits the secretion of VEGF at the level of transcription.

A tiered approach in mandatory assessment training

What problems were addressed? The General Medical Council (GMC), which regulates and assures the quality of basic medical education in the UK, currently requires that all medical school assessors are trained appropriately. At the University of Southampton, medical students conduct their clinical placements at National Health Service (NHS) Trust hospitals in Southampton and across southern England and, more recently, in Kassel, Germany. Previously, assessor training consisted of optional, Southampton-based, face-to-face training. Mandating training for clinical assessments such as the observed structured clinical examination (OSCE) and work-based assessments (mini-clinical examination [mini-CEX]) was particularly challenging. These challenges relate to the large numbers of assessors required, their high turnover, dispersed geographical locations, limited availability for attendance at training events, and differing levels of expertise. What was tried? We reused content and resources from face-to-face clinical assessment trainings and developed a three-tiered structure with a compulsory basic training (T1) and two optional more advanced trainings (T2, T3). In the OSCE training, the tiered approach comprises: T1, a 30-minute OSCE briefing video that is e-mailed to examiners; T2, flexible online training, and T3, a half-day faceto-face workshop. All the tiers cover basic principles and guidelines to ensure that the OSCE is carried out appropriately. Training in T2 and T3 additionally facilitates a benchmarking process in which examiners are able to practise and to receive feedback. In T2, this is achieved through scoring a video of a student completing an OSCE station and then comparing marks with those of peers and an expert panel. In T3, examiners practise by performing a mock OSCE task involving simulated patients and student volunteers, and are then given an opportunity to compare and discuss their marks. What lessons were learned? Since the tiered approach was introduced (2014–2016), 100% of OSCE examiners (n = 150 per year) have completed the mandatory T1 training and 80% have completed more than the mandatory basic training (T3, 60%; T2, 20%) Our approach enabled us to reach a further almost 40% of examiners who would not have been trained before the introduction of tiers. The training records of all OSCE examiners in our database (n = 789) demonstrate the overall uptake of T3 and T2 and show that 49% of examiners completed T3, 17% completed T2 and 4% undertook both T2 and T3. Although examiners engaged with T2, we need to promote it further to raise its uptake. We found that examiners who completed both T2 and T3 started with T2 and then opted to undertake the more advanced T3 training later. Although we mandate only T1, signposting examiners to higher tiers has also encouraged them to move beyond this minimum level. The tiered approach can also operate in the opposite direction whereby some examiners use T1 as refresher training after attending a workshop. We were also able to reuse resources in different modalities, such as by using videos from online training to stimulate discussion in workshops. We also used content from T2 and T3 to produce material for T1, which helps to improve efficiency and emphasises the messages consistently. The tiered approach enabled us to comply with GMC regulations, to address differing examiner learning needs and to offer flexibility to geographically dispersed faculty staff. We are currently rolling out this tiered approach in non-clinical assessments.

Log In to Experiential Learning Theory: Supporting Web-Based Faculty Development

Background For an increasingly busy and geographically dispersed faculty, the Faculty of Medicine at the University of Southampton, United Kingdom, developed a range of Web-based faculty development modules, based on Kolb’s experiential learning cycle, to complement the faculty’s face-to-face workshops. Objective The objective of this study was to assess users’ views and perceptions of the effectiveness of Web-based faculty development modules based on Kolb’s experiential learning cycle. We explored (1) users’ satisfaction with the modules, (2) whether Kolb’s design framework supported users’ learning, and (3) whether the design principle impacts their work as educators. Methods We gathered data from users over a 3-year period using evaluation surveys built into each of the seven modules. Quantitative data were analyzed using descriptive statistics, and responses to open-ended questions were analyzed using content analysis. Results Out of the 409 module users, 283 completed the survey (69.1% response rate). Over 80% of the users reported being satisfied or very satisfied with seven individual aspects of the modules. The findings suggest a strong synergy between the design features that users rated most highly and the key stages of Kolb’s learning cycle. The use of simulations and videos to give the users an initial experience as well as the opportunity to “Have a go” and receive feedback in a safe environment were both considered particularly useful. In addition to providing an opportunity for reflection, many participants considered that the modules would enhance their roles as educators through: increasing their knowledge on various education topics and the required standards for medical training, and improving their skills in teaching and assessing students through practice and feedback and ultimately increasing their confidence. Conclusions Kolb’s theory-based design principle used for Web-based faculty development can support faculty to improve their skills and has impact on their role as educators. Grounding Web-based training in learning theory offers an effective and flexible approach for faculty development.